With the UK and other countries still reeling from the global economy’s financial hangover, governments around the world are trying to work out how to maintain high standards of healthcare while cutting costs on a service that takes up a large slice of most national budgets.

Attempting to balance quality and accessibility with reduced costs is a tightrope for government officials to walk. The UK’s coalition government has been forced into several embarrassing U-turns, as the public understandably criticises any move to privatise or downsize the country’s cherished National Health Service (NHS).

The introduction of sophisticated mobile units, capable of conducting procedures from MRI scans to full surgery, could be an innovative way to make healthcare more local and more cost-effective. Not all agree, however; last month the Vancouver Island Health Authority (VIHA), Canada, decided to reject proposals to introduce new mobile MRI machines to increase accessibility to this imaging procedure on the grounds that costs would be prohibitively high.

So what can be achieved with the latest mobile medical units, and do they offer a viable vision of our healthcare future, one in which fully-loaded hospitals are superseded by a network of responsive, mobile units that can react to demand?

We spoke to Vanguard Healthcare’s managing director Ian Gillespie, whose company operates the UK’s largest fleet of mobile healthcare units, to find out.

Chris Lo: Could you start by giving a little background on Vanguard’s fleet and your main customers?

“If you’re trying to marry up a fixed infrastructure to variable demand, you’re invariably going to run into problems.”

Ian Gillespie: Vanguard is a ten year-old company that is still very new and innovative in the world of healthcare delivery.

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We have a fleet of 40 units; the service that we’ve got is three-fold.

We provide the mobile infrastructure itself, and that’s a range of operating theatres, clinics, wards and endoscopy suites. We provide them with equipment if needed, and we also provide the staffing element if needed.

When I say staff, it’s the support staff. It’s not the consultants themselves, but if a customer is looking for additional support to manage the service, we can provide that. Our customer base is primarily the NHS, which makes up about 80% of our business, and 20% is private providers.

CL: In your experience, for what reasons do hospitals or primary care trusts (PCTs) consider purchasing or hiring mobile units?

IG: There are typically six key reasons, but two are the primary ones. The first is that the NHS and the private hospital estate in the UK are quite aged and in fixed locations.

The second big driver for the business is refurbishment. Again, it’s an aging estate. If a customer is refurbishing an operating theatre to put in the latest technology or, as is the case in some of the NHS places, if they’ve discovered asbestos as a result of a building’s age, mobile units could be brought in for the length of the refurbishment programme. That means that the patient doesn’t get disrupted during the work that goes on.

CL: Vanguard has been expanding into Europe – are there any differences in the markets on the continent?

IG: It’s very interesting. The simple answer is that we’ve selected the geographies in Europe that are most similar to the healthcare system in the UK, for ease of market entry.

“The key thing is making sure the technology that you use in a mobile is compressed and modified for use in a mobile.”

So looking at Holland, the Nordic and Italy, we believe the dynamics of the market in these countries have a lot of similarities to the UK – there’s a mix of private and public, there are very sensible and high-level quality demands, both from the state and from the patients themselves. There is also a drive to treat patients within a respectable period of time. So we picked those countries because of that. If you look more broadly, France and Germany have got similar drivers, but are probably less attractive to us initially, because in France there’s a 50/50 private-public split which makes the dynamic of the market slightly different, and in Germany there’s probably what you’d define as over-capacity at the moment, so there’s probably less of a need for a Vanguard solution.

CL: What are the most important things that customers expect from a mobile service?

IG: Whenever you’re dealing with healthcare, your prime motivator is "Can I do something that’s safe and effective?" Whenever you talk to somebody about the use of a mobile, if they haven’t seen what Vanguard can provide, their first thought is typically "Hmm, I’m not sure I want carry out an ophthalmic procedure or an orthopaedic procedure in a mobile unit." In their head, they might be thinking of a mobile library or a converted bus or something. So that’s the key thing, overcoming the reluctance to try something different.

CL: Are you planning on expanding into new clinical areas, medical imaging for example?

IG: I think those services are complementary, but they’re very different. Our company philosophy is to stick with our key strength of the operating theatre business.

CL: What are the main challenges when it comes to offering a comparable patient experience in such a different clinical setting?

IG: A theatre is essentially a mix of four or five different systems. It’s an air system, so the first challenge is making sure that in a mobile unit you can have an air handling system that gives you the clean operating environment that you would expect in a fixed facility.

The gas system – you’ve got to make sure you’ve got effective oxygen and vacuum systems that can be used easily. You’ve got to have a water system that’s safe and effective, so no legionella or anything else is present.

And then you’ve got to have an electric system that works, because again, in an operating environment your systems have to be compliant with the latest technology, so you’ve got uninterruptible power supply, exponential earth bonding and so on.

The key thing is making sure the technology that you use in a mobile is compressed and modified for use in a mobile. The challenge is space – it’s got to fit in the back of a truck, it’s got to be delivered quickly, it’s got to fit on UK roads. So you’re physically limited by the actual size of the vehicle. We have to make sure the vehicle can be as small as possible, but when the unit arrives it’s as large as possible. For that, we use slide-outs. Whenever you look at a truck it’s quite small, but when it’s delivered it’s much bigger. The units are delivered and they slide out to extend way beyond their footprint when their on the back of a truck.

CL: What do you think could be possible in mobile units in the future?

“We see the opportunity for healthcare provision in the UK to go to a much more dispersed model of care.”

IG: I think if we talk about the UK specifically, with the change in legislation recently, the move to any qualified provider [AQP] presents a huge opportunity for dispersed models of care.

Historically, care has been delivered from fixed sites, which are in specific locations. We see the opportunity for healthcare provision in the UK over the next five to ten years to go to a much more dispersed model of care. This has got two elements – one is the ability to deliver care on a circuit basis, so you can have a mobile operating theatre going to point A, B and C on a monthly basis, changing around at particular geographies, so you’ve got localised service, both for inpatients and outpatients.

That’s a model that’s been tried-and-tested in a couple of clinical specialities, particularly ophthalmics, cataract surgery, and it’s been very effective.

The other way to deliver dispersed models of care is a term that I use – health ports. Instead of building a very expensive clinical facility with operating theatres and imaging systems, you build a cheap, flexible facility that’s got a reception area, toilets and consulting rooms, and that’s it. Then all of the high-tech, expensive, complex equipment is brought in on an as-needed basis.

It would just hook up to a docking station. So you’ve got a cheap, small fixed facility that’s got the core patient facilities, then you can bring in an operating theatre, an endoscopy unit, an MRI machine on an as-needed basis and dock it up to the health port. If you look at those two concepts, you can dramatically change the cost infrastructure of healthcare in the UK, you can dramatically change the patient experience, you can bring down waiting times, you can get rapid response and you can increase local outpatient activity in the community. All of this can be done, as well as starting to downsize hospitals, without the public outcry that happens whenever you try to close a hospital today. What you’re doing is replacing that hospital with a more local, more effective model of care.